动脉血乳酸清除率及碱剩余在感染性休克患者中的动态监测价值

Dynamic monitoring of the rates of arterial blood lactate clearance and base excess in patients with septic shock

目的:探讨动脉血乳酸、乳酸清除率及碱剩余水平对感染性休克患者治疗效果及病情判断的评估价值。方法:回顾性分析合肥市第三人民医院ICU自2011年4月至2013年4月临床资料完整的感染性休克患者,根据患者生存情况分为存活组26例,死亡组18例,分别比较两组患者入院时及治疗6、12、24、48 h的血乳酸、乳酸清除率及碱剩余水平,分别将患者入院时APACHEⅡ评分与治疗6 h后的血乳酸、乳酸清除率与碱剩余及乳酸清除率与碱剩余之间进行相关分析。结果:存活组入院时及治疗6、12、24、48 h的血乳酸水平均低于死亡组,乳酸清除率及碱剩余水平均高于死亡组,差异均有统计学意义;Pearson相关分析显示血乳酸与APACHEⅡ分值呈正相关(r为0.83),6 h乳酸清除率、碱剩余与APACHEⅡ分值呈负相关(r为-0.57、-0.75),6 h乳酸清除率与碱剩余之间呈正相关(r为0.85)。结论:乳酸清除率及碱剩余能较好评估感染性休克的严重性及治疗效果,动态监测两者变化可以作为危重症患者病情评价的指标。

Objective To investigate the levels of arterial blood lactic acid, lactate clearance and base excess in evaluation of treatment efficiency in patients with septic shock. Method Restrospective analysis was performed on the complete clinical data of patients with septic shock in the ICU of Hefei Third People＇s Hospital from April 2011 to April 2013. Based on the survival results, 26 cases were enrolled into the survival group and 18 cases were enrolled into the death group. The levels of blood lactate, lactate clearance and base excess of patients were determined at 6 h, 12 h, 24 h and 48h after admission. Correlation analysis was performed on admission APACHE ]] score with lactic acid, lactic acid clearance, base excess at 6 h post treatment. Results The blood lactate levels of patients in the survival group were lower than those in the death group at 6 h, 12 h, 24 h and 48 h post treatment, while the rates of lactate clearance and base excess were significantly higher than those in the death group. Pearson correlation analysis showed that the blood lactic acid and APACHE H scores were positively correlated （r = 0.83）, the rates of lactate clearance and base excess at 6 h post admission were negatively correlated with APACHE H score （r = -0.57, -0.75）. The rates of lactate clearance and base excess at 6 h post admission were positive correlation （r = 0.85）. Conclusion The rates of lactate clearance and base excess canbe used to assess the severity and treatment efficiency of patients with septic shock. The dynamic monitoring of the rates of lactate clearance and base excess can be used as indicators of the evaluation of the conditions of critically ill patients.